Am J Med Qual
· 2025 Jul-Aug 01 · PMID 40289319
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Physicians encounter several challenges with current billing processes. The current Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review identifies and characterizes quality improve...Physicians encounter several challenges with current billing processes. The current Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review identifies and characterizes quality improvement (QI) strategies to enhance physician billing. MEDLINE, EMBASE, HealthStar, and Web of Science were searched for studies that described QI interventions targeting practicing or trainee physicians and outcomes including improved efficacy, enhanced efficiency, accurate billing code selection, or increased satisfaction. Fifty-six of 11,621 studies met the inclusion criteria. More than 40% of studies utilized more than 1 intervention and over 60% of studies included an educational intervention. Revenue-related outcomes were commonly reported among included studies (n = 30, 54%), followed by accuracy or error rates (n = 22, 43%), and billing completion rates (n = 14, 25%). QI interventions to enhance physician billing tend to be lower on the hierarchy of intervention effectiveness. Future work should explore the durability and generalizability of interventions and their impact on physician and patient outcomes.
Goldman J, Wong BM, Hawker G
… +2 more, Levinson W, Shojania KG
Am J Med Qual
· 2025 Sep-Oct 01 · PMID 40289314
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Despite widespread attention to addressing healthcare quality problems, few academic medical centers provide an academic pathway for faculty engaged in such work. This qualitative case study examined physicians and depar...Despite widespread attention to addressing healthcare quality problems, few academic medical centers provide an academic pathway for faculty engaged in such work. This qualitative case study examined physicians and department leaders' perceptions and experiences of a novel "Clinician in Quality and Innovation" (CQI) academic pathway created in 2012. Interviews were conducted with 23 CQI faculty and 7 department leaders. Of the department's 20 divisions, 15 included at least one CQI with a median of 5 per division. Findings demonstrated how the academic track aligned with, and legitimized, CQIs' interests, and allowed for a wide range of "quality and innovation" activities (eg, improving healthcare processes, developing models of care, clinical informatics). Contextual factors such as synergies with hospital-based initiatives for healthcare improvement and changes to academic promotion criteria were instrumental in CQI's performance of the academic role. Despite promotion successes, CQIs described some tensions between academic and clinical role expectations.
Betti S, Bell H, Glatt J
… +2 more, Yoo EJ, Oxman DA
Am J Med Qual
· 2025 Jul-Aug 01 · PMID 40279241
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Exposure keratopathy (EK) is corneal damage from prolonged environmental exposure. If untreated, EK can lead to corneal scarring and/or blindness. Critically ill patients are at high risk. A case of EK in our intensive c...Exposure keratopathy (EK) is corneal damage from prolonged environmental exposure. If untreated, EK can lead to corneal scarring and/or blindness. Critically ill patients are at high risk. A case of EK in our intensive care unit led us to investigate the incidence of EK in our critical care units and understand the interventions needed to reduce its impact. We found 44 cases of EK over 3 years. 95% received mechanical ventilation and 32% received paralytic agents. Average time to diagnosis was 15.8 days from intensive care unit admission. More than a quarter (27%) of patients had severe EK at diagnosis, and 52% of patients had received prior eye care. EK occurred frequently in our critical care units. Many subjects did not receive prophylaxis and disease was diagnosed at a late stage. To address this, we plan a 3-pronged approach focusing on prevention, early recognition, and timely initiation of treatment.
Am J Med Qual
· 2025 Jul-Aug 01 · PMID 40279208
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This paper explores the concept of high reliability within clinical laboratories and its critical role in ensuring accurate and trustworthy diagnostic results. It examines the intrinsic connection between quality and rel...This paper explores the concept of high reliability within clinical laboratories and its critical role in ensuring accurate and trustworthy diagnostic results. It examines the intrinsic connection between quality and reliability in patient care, emphasizing the importance of robust quality management systems and the expertise of laboratory professionals. The paper outlines the 5 pillars of a high-reliability organization and discusses the significance of eliminating preventable harm through standardized protocols. Furthermore, it addresses the complexities of change management, utilizing the Kübler-Ross Change Curve and McKinsey's 7S model to facilitate staff engagement and resilience during transitions. By integrating systematic approaches to quality control and human performance, the paper advocates for a culture of continuous improvement aimed at achieving high reliability and a zero-harm environment in clinical laboratories. Ultimately, the journey toward high reliability is presented as an ongoing commitment to excellence in patient care, highlighting the need for effective leadership and employee collaboration.
Deering TF, Smith AM, Gillespie JA
… +16 more, Simonson J, Gouveia-Pisano J, Jackson M, Blithe T, Somand H, Medico CJ, Schuleri KH, Budzyn ML, Zand R, Chaudhary D, Jain SK, Coons JC, Byers EM, Dueweke E, Solano F, Catanzaro JN
Am J Med Qual
· 2025 Jul-Aug 01 · PMID 40241409
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There are significant gaps in care for patients with atrial fibrillation (AF) and is a need to focus on improving guideline-concordant care. Recognizing challenges encountered in pursuing sustainable quality improvement...There are significant gaps in care for patients with atrial fibrillation (AF) and is a need to focus on improving guideline-concordant care. Recognizing challenges encountered in pursuing sustainable quality improvement (QI) in AF care, the Heart Rhythm Society spearheaded a multifaceted collaboration grounded in the principles of Improvement Science to develop a robust platform aimed specifically at demystifying QI for clinicians and health care systems interested in closing care gaps for patients with AF. Solution development included an innovative discovery process, a design phase, piloting, and refinement, and finished with transformation into a comprehensive digital platform. End-users were engaged throughout the 4-phase process to help ensure the final platform would meet the needs of clinicians and health care systems. The result was the launch of www.CardiQ.org featuring the Atrial Fibrillation QI Framework and an extensive, curated Resource Library that has been accessed by more than 10 000 users spanning over 100 countries.
Hsu YJ, Speed TJ, Prinzbach A
… +9 more, Sutton O, McDonald EM, Khasawneh A, Kim S, Samba I, Shechter R, Hanna MN, Marsteller JA, Xie A
Am J Med Qual
· 2025 Jul-Aug 01 · PMID 40091179
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Efforts to improve patient engagement in pain management are often hindered by inconsistent definitions and measurements. To address this gap, we developed and pilot-tested the 15-item Patient Engagement in Pain Manageme...Efforts to improve patient engagement in pain management are often hindered by inconsistent definitions and measurements. To address this gap, we developed and pilot-tested the 15-item Patient Engagement in Pain Management survey. A systematic review of 77 survey instruments identified 6 key constructs of patient engagement, and semi-structured interviews with 36 patients and 3 providers from the Johns Hopkins Personalized Pain Program informed its development. The initial 33-item survey was refined to 15 items, and usability and test-retest reliability were evaluated with 60 Personalized Pain Program patients. The median completion time was 3.5 minutes, with minimal missing data (<0.5%). Most respondents (96-100%) found the questions relevant, with higher average scores for patient-provider communication (3.6-4.5 on a 5-point scale) and lower scores for adherence challenges. Although the Patient Engagement in Pain Management survey demonstrated good usability and applicability, further studies are needed to enhance its test-retest reliability and psychometric validation.
Savel RH, Benson P, Collins C
… +6 more, Gongireddy S, Oquendo C, Gyekye K, Villar-Trinidad E, Fennimore J, Akunyili I
Am J Med Qual
· 2025 Jul-Aug 01 · PMID 40069926
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This study explored the independent risk factors for patients giving a less than "top box" score on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys in the "doctor communication" do...This study explored the independent risk factors for patients giving a less than "top box" score on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys in the "doctor communication" domain (DCD). After adjusting for age, gender, length of stay, receiving a postdischarge phone call (PC), new medication during hospitalization, highest education level, language spoken at home, and zip code, results from 803 HCAHPS surveys (from January 1 to December 31, 2023) revealed that not receiving a PC was associated with a more than doubling of the odds that a patient would give less than a "top box" score for the DCD (overall adjusted odds ratio of 2.22; 95% confidence interval: 1.77-2.78) and a nearly doubling the actual probability of doing so (34.3% less than "top box" score if no PC, 17.9% less than "top box" score if PC). These findings support the potential value of a post-discharge patient PC.
Am J Med Qual
· 2025 May-Jun 01 · PMID 40069925
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Risk adjustment plays a key role in payment, especially in value-based payment models, which use a practice's performance with cost and quality metrics to determine reimbursement. Inaccurate representation of a patient's...Risk adjustment plays a key role in payment, especially in value-based payment models, which use a practice's performance with cost and quality metrics to determine reimbursement. Inaccurate representation of a patient's medical complexity can cause a practice to fall below cost and/or quality performance targets, potentially leading to a substantial loss of shared savings dollars. This quality improvement study evaluated the effectiveness of a clinical documentation excellence program, focused on addressing hierarchical condition category diagnoses, involving the medical specialties. The program included tools in the electronic health record, metrics to monitor and provide feedback on clinician performance, and regular interactions with the nurse and physician leads for each specialty. For clinicians of medical specialties, the education program resulted in an increase in the percentage of hierarchical condition category diagnoses addressed at outpatient encounters from 25% to 62% over a 2-year period.
Lohr K, O'Connor C, Shapiro T
… +4 more, Gamburg S, Bhagat P, Colangelo F, Cooper MR
Am J Med Qual
· 2025 May-Jun 01 · PMID 40059297
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Chest pain is one of the most common presenting complaints to emergency departments in the United States, and management centers on identifying myocardial infarction or other forms of rare but problematic cardiac diagnos...Chest pain is one of the most common presenting complaints to emergency departments in the United States, and management centers on identifying myocardial infarction or other forms of rare but problematic cardiac diagnoses. The high-sensitivity troponin assay can detect abnormal troponin elevations at 10- to 100-fold lower levels compared with traditional troponin assays and thus can allow faster time to disposition and diagnosis, yet adoption has not been universal. Implementing a high-sensitivity troponin protocol with a risk prediction algorithm can decrease the numbers of patients admitted, reduce unnecessary testing, and shorten patient stays in the emergency department. This quality improvement project was undertaken in a community-academic health system lacking a system-wide protocol to workup patients presenting with chest pain to the emergency department. Key stakeholders evaluated multiple barriers and identified measures, planned implementation of the new assay and its associated algorithm, led postimplementation data monitoring and analysis, and delivered progress reports to organizational leaders. Chest pain admissions were managed by hospitalists in the absence of a cardiology inpatient service. The most important barriers were found to be individual provider strategy, electronic medical record design, and the lack of capacity for cardiology evaluations in both inpatient and outpatient settings. Stakeholder buy-in, monthly data reports, team meetings, and widespread education were used to support the changes in ordering patterns and evaluation. Postimplementation, 3293 patients were assessed over a 12-month period. Baseline mean length of stay for chest pain in the emergency department decreased from 297 minutes (SD, 53) to 274 minutes (SD, 33; P = 0.03). Hospital chest pain observation admissions decreased from 23% to 14% of patients presenting with chest pain ( P <0.001). Stress tests ordered for observation patients decreased from 12 per month to 3 ( P <0.001). Similarly, in observation patients, echocardiograms decreased from 61 to 46 per month ( P <0.001), cardiology consultation decreased from 125 per month to 81 ( P <0.001), and cardiac catheterization decreased from 41 per month to 32 following the intervention ( P = 0.003). Developing a standardized management protocol and selecting physician leaders to maintain and revise protocols were high-impact, low to moderate-effort interventions resulting in significant changes in practice. This study demonstrated that a high-sensitivity troponin assay, combined with a chest pain clinical management protocol based on the Heart, EKG, Age, Risk factor, Troponin score, was able to achieve a reduction in emergency department length of stay, a decrease in hospital observation admissions, and reduced cardiac testing in this patient population.
Am J Med Qual
· 2025 May-Jun 01 · PMID 40051086
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A novel volunteer program was implemented in the adult emergency department waiting room to combat declining patient satisfaction, a crucial quality metric impacting everything from hospital reimbursement to clinical out...A novel volunteer program was implemented in the adult emergency department waiting room to combat declining patient satisfaction, a crucial quality metric impacting everything from hospital reimbursement to clinical outcomes. Net Promotor Scores (NPS) were tracked in a retrospective cohort design, with patients interacting with volunteers serving as the intervention cohort and those who did not serving as control. Analysis using monthly NPS means was conducted from 2022 to 2023. The absolute difference in NPS between the 2 groups was 17.43. Using monthly means, an unpaired t -test was conducted. NPS in the intervention group was 51.86 with a standard deviation of 7.01. NPS in the control was 34.43 with a standard deviation of 5.32. Data is significant, with P = 0.0002. This emergency department waiting room volunteer program led to increases in patient satisfaction. Study authors think similar effects are achievable at other institutions, and future trials would be beneficial in confirming this suspected causal relationship.
Das IG, Bryan Ringel J, Rajan M
… +3 more, Colantonio LD, Safford MM, Kern LM
Am J Med Qual
· 2025 May-Jun 01 · PMID 40051084
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This nationwide cross-sectional study explored the relationship between ambulatory care fragmentation and medication use in older US adults, examining variations by chronic conditions and race. Utilizing data from the 20...This nationwide cross-sectional study explored the relationship between ambulatory care fragmentation and medication use in older US adults, examining variations by chronic conditions and race. Utilizing data from the 2003-2016 REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study linked with fee-for-service Medicare claims, the authors analyzed care fragmentation (measured by the reversed Bice-Boxerman Index) and medication counts through a 2-week in-person prescription inventory. They employed negative binomial regression, adjusting for potential confounders, and conducted subgroup analyses based on chronic conditions and race. Of the 4524 participants, 40.7% experienced high care fragmentation and 59.8% used 5 or more medications. High fragmentation was associated with a 4% overall increase in medication count ( P = 0.03), a 7% increase for those with 4+ chronic conditions ( P = 0.01), and a 9% increase for Black participants ( P = 0.01). In conclusion, fragmented care is independently associated with greater polypharmacy, particularly among Black older adults and those with multiple chronic conditions.
Labordus-van Helvoirt R, Mangione J, Quality Committee and Science Committee of the Association of Hospitalists – Vereniging voor ZiekenhuisGeneeskunde (VvZG)
Am J Med Qual
· 2025 May-Jun 01 · PMID 40051081
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Waheed A, Umer M, Paracha A
… +5 more, Latif A, Malik N, Fatima H, Atif SM, Azhar E
Am J Med Qual
· 2025 May-Jun 01 · PMID 40051070
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Timely closure of patient encounters and addressing tasks in the Electronic Health Record (EHR) inbox are essential for quality care and efficiency. Delinquent items in the EHR inbox impact patient care, cost of care, an...Timely closure of patient encounters and addressing tasks in the Electronic Health Record (EHR) inbox are essential for quality care and efficiency. Delinquent items in the EHR inbox impact patient care, cost of care, and overall patient and provider experience. This project aimed to improve the management of these items using a quality improvement initiative with a bundled intervention. This study was conducted using a quasi-experimental method with interrupted time series. Stakeholders were engaged to define policies and expectations based on root cause analysis. Interventions included creating policy and procedures with clear expectations, creating resources, addressing inbox management delinquency using Just Culture with consoling, coaching, and disciplining. Simple rubrics using the situation-behavior-impact framework and motivational interviewing questions were used for coaching. Data were analyzed using JMP Pro 16 with statistical process control charts for phase analysis. Poisson regression was used to explore statistically significant trends after the implementation of the intervention bundle. The average number of open encounters decreased from 71 per week preintervention to 33.8 per week in the rollout period, and 12.2 per week postintervention. The phase analysis on individual moving range control chart showed a significant shift in the process after the implementation of the intervention. Poisson regression showed a 78% decrease in the number of delinquent items ( P < 0.001) after the implementation of the bundled intervention. A multifaceted intervention significantly improved EHR inbox management with potentially positive impact on the quadruple aim.